Skip to main content

Gut Assessment and Treatment Planning by Pierre Brunschwig, MD

Why does the gut matter?
Did you know that the gut can be a source of distress physically and psychologically?
Come join us as Dr. Pierre Brunschwig talks about Gut Assessment and Treatment Planning.


We’re struggling to pull this together. I often mention to patients, I say you know, we’ve learned a lot but it’s a little frustrating sometimes because it’s as if you’d opened the closet door, and briefly you click the light on and briefly, the light bulb shines, and then poof, it’s off. And what you saw was not a closet, but the doorway to a stadium. And so, what you can see with that first flash of light was only just the first few chairs. And this is where we are. We know there’s a whole stadium worth of information that will someday soon, we hope, become the basis of real insights, and really very specific kinds of treatments using the microbiome.

Why the gut matters: The gut can be a source of distress physically and psychologically.

The brain is quite dependent on the gut for the absorption of the nutrients that it needs to do its normal functions.

Malabsorption syndromes and other kinds of gut disturbances that result in nutritional deficiencies will affect the gut. The gut, also, when it’s not healthy is the source of inflammatory cytokines. These cytokines can travel broadly and increase inflammation in the brain. For people who have chronic gut disorders, the gut is a source of psychological and physical distress.

Gluten Intolerance/ Celiac Disease in Psychiatry

Remember that gluten, more than any other food allergy, is likely to provoke autoimmune disease. And then you look for anti-brain antibodies in schizophrenics, nearly half of them have it. There are associations in research, where they show that there’s non-Celiac gluten sensitivity associated with eating disorders. Gluten sensitivity and Celiac disease, because it’s researched this way, is one or the other. We see different symptom complexes in the two. In Celiac disease, you’re much more likely to see diarrhea. In non-Celiac gluten sensitivity, you’re much more likely to see constipation. Nutritional deficiency is much more common in Celiac disease and much less common in non-Celiac gluten intolerance, although I will say when they talk about deficiencies of vitamin D less than 10, that’s pretty severe. Many people with non-celiac gluten intolerance will have deficiencies in vitamin D that are in the 10 to 30 range.

Key findings in maldigestion 

We distinguish malabsorption from maldigestion this way. We think you first must break the food down into its constituents in order to absorb it. If you don’t do this first step, then that’s maldigestion. You may have both. You may maldigest the food, you may lack enzymes, acid, bile acids, proper amount of time for all this reaction to happen in order for digestion to be complete. And you may also malabsorb for other reasons. So, on stool testing, the most common way that we see this is with human pancreatic elastase as a marker for the production of pancreatic enzymes. Not a foolproof test, but very useful.